Itchy rash near the navel
Tinea corpus
Tinea corpus is a dermatophyte infection of the body. These lesions are typically oval and pruritic. Tinea corpus lesions tend to enlarge slowly with a clearly demarcated, slightly raised, erythematous border and central clearing. Satellite lesions may be seen. Applying topical steroids to tinea corpus may result in initial improvement with subsequent flare as the body’s immune response is suppressed.
Pityriasis rosea
Pityriasis rosea is a common pruritic exanthem that can begin as a solitary lesion on the trunk (herald patch). The herald patch is typically an erythematous oval lesion several centimeters in size with a collarette of scales along its border. Typically, within a week numerous other salmon-colored lesions appear on the trunk along Langer’s lines.
The age of peak incidence is during the third decade of life but it does develop in children. Therapy is conservative and targets the control of pruritus.4
Treatment: A simple solution
The mainstay of therapy is avoidance of nickel-containing metals. Buttons can be replaced with plastic ones, or covered with cloth. Patients should not coat buttons with nail polish—it doesn’t work very well.
Stainless steel is a good option for piercings because nickel tends to be tightly bound within the alloy. Topical steroids can be used to speed resolution of the rash and antihistamines may help with pruritus.
Outcome
The patient was placed on a topical steroid (triamcinolone 0.1% ointment). His mother sewed a piece of cloth over the inside of all his pants buttons. The ointment was only given because the mother wanted something that would make the rash go away quickly. Within a week, he was no longer itching and his rash was nearly gone.
CORRESPONDENCE
Dean A. Seehusen, MD, MPH Department of Family and Community Medicine, Eisenhower Army Medical Center, Fort Gordon, GA 30509 E-mail: dseehusen@msn.com
